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Welcome and Background to today’s Workshop

Welcome and Background to today’s Workshop. Laurence Dubourg 8 October 2004. DOSA Benchmarking group. Created in June 2001 Benchmark performance at state level Enhance DOSA rate ~ from 2001 Enhance SDS rate ~ from 2002. Underlying Principles.

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Welcome and Background to today’s Workshop

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  1. Welcome and Background to today’s Workshop Laurence Dubourg 8 October 2004

  2. DOSA Benchmarking group • Created in June 2001 • Benchmark performance at state level • Enhance DOSA rate ~ from 2001 • Enhance SDS rate ~ from 2002

  3. Underlying Principles • Learning from the bests – support when the worst • Data is required to produce change (Deming) • Education required to change culture • Organisational specific data required to profile own practice to that of their peers • References: • Wilson et al, Aus; 1995. • Johnson et al; USA; Mar 1996

  4. How did it start • Austin CEO wrote to all CEO’s asking for representation @ benchmark DOSA working party • Representation volunteered from country and metro • DHS invited • DHS supportive

  5. Key achievements • Developed definitions to accurately benchmark DOSA and SDS • Developed processes to collect data • Developed rules to distribute comparative data • Developed confidentiality agreement to enhance trust • Improve rates in a a co-operative and non-competitive manner • DHS Learnt from users: • Barriers • Successes • what works • what does not work • why…

  6. Calculation of DOSA • NOMINATOR • DENOMINATOR Number of patients whose admission date = surgery day & non same day Total number of elective surgical separations - Non same day - included in ESIS abstract

  7. Culture snap shot back then March 2002 When DOSA rate was at 65% A survey of clinicians was performed • To ascertained their views • On should patients be DOSA or not DOSA • Are there opportunities for improvements

  8. ASA1 (healthy patients)

  9. ASA2(patients with mild systemic disease)

  10. ASA3 (significant / not incapacitating disease)

  11. ASA4 (with incapacitating disease)

  12. From what age is DOSA a ‘no’

  13. HITH for pre-operative period

  14. From 2001 to 2004 • From 2001, the DOSA rate moved from 65% • to more than 90% by 2002 and continued to grow since • In May 2002, the group moved to benchmarking SDS • The group identified key DRG’s • Then defined data calculation and processes

  15. Calculation of SDS • NOMINATOR • DENOMINATOR Number of patients whose discharge date = surgery day Total number of elective surgical separations in these basket - included in VAED data set

  16. Basket of Procedure • Common procedure • Has the potential to be a day case • Performed in a wide range of hospitals • Arthroscopies • Lap Chole • Hernia • Local lesions • Haemorrhoidectomies • Tonsillectomies • Bronchoscopies • Cataracts • Removal metal Simon Jolly – data - DHS

  17. Learnings • PM lists make SDS difficult • Medi-hotels for patients not discharged late at night • Patients expectation to be aligned from before admission • Same day surgery pamphlets do not ‘encourage overnight bag’ in case… • Quote from the minutes: • Arlene Wake discussed ‘the joys of changing the scheduling of OT sessions, at the Alfred, so SDS sessions chiefly commence at 0830’ …

  18. Evaluation of the group’s activities • Evaluated late 2003 • Review explored: • Achievements • Strategic direction • Review through a survey of regular members (11): • Response rate 90% • Rural members 3 • Metro members 7 • Other characteristics of responses • New Members 3 • Department of Human Services 1 • Regular and early attendees 7

  19. Appropriateness of Objectives • Data calculation for DOSA 10/10 • Data calculation for SDS 10/10 • Implementation of benchmarking processes 9/10 • Monitor data collection process 9/10 • Enhancing data integrity 9/10 • Enhancing communication with DHS 9/10 • Enhance partnerships across states 9/10 • Facilitate Networking 9/10 • Support others towards rate increase 9/10

  20. Achievements • DOSA YESNO REPLY NO • Definition/calculations 9 1 0 • Data collection process 6 2 2 • Learning from each other 7 1 2 • Report sharing 9 1 0 • SDS • Definition/calculations 9 1 0 • Data collection process 6 3 1 • Learning from each other 7 2 1 • Report sharing 9 1 0

  21. What would we have done differently • Involve the country more • Run more workshops on topics to formalise exchange of strategies • Targeted definite specific DRG

  22. Strategic development • Rural involvement increased • Positive to be able to raise issues with DHS • Continue to enhance working relationships between hospitals • Explore formal sharing through conference • Increase medical involvement • Be mindful of time other state forums

  23. Outcome for 2004 • Run a workshop relevant to a Same day Surgery selected DRG: • High throughput DRG • High variance DRG • Possible higher rate • MESSIG can fulfil the DOSA SDS improvement objectives and add more • Benchmarking group folding today

  24. From the chairperson • This has been a great group • It has met its objectives • Members have • Formed lasting relationships • Worked wonderfully well together • DHS has provided outstandingly support - all the way • Rewarding chairperson experience • Thank you

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